MNJ (Malang Neurology Journal)

GIANT ARACHNOID CYST WITH SPONTANEOUS SHRINKING: A CASE REPORT

2022-05-19T04:03:42+00:00

Arachnoid cysts occur in approximately 1% of all intracranial space-occupying lesions and do not require a very high rate of surgical intervention. Arachnoid cysts are cystic formations containing cerebrospinal fluid. It is argued that the enlargement of the arachnoid cysts increases in volume with the unilateral valve mechanism. They are generally considered static formations because they do not tend to grow. A 16-year-old male patient was evaluated for headache attacks resistant to medical treatment. A giant arachnoid cyst located in the left temporal region was detected in the cranial MRI examination of the patient who had no history of head trauma or cranial operation in his medical history. In the MRI examination two years later, it was seen that the arachnoid cyst had almost completely disappeared. However, it was also found that it caused cambering in the temporal bone in the adjacent region. This finding supports that not all arachnoid cysts are static formations; they may have their internal dynamics and even cause shape changes in the surrounding tissues and even the cranium.

KERNOHAN’S NOTCH PHENOMENON IN AN ACUTE COMPONENTED CHRONIC SUBDURAL HEMATOMA PATIENT: A CASE REPORT

2022-07-12T04:11:46+00:00

Kernohan's notch phenomenon is a rare examination finding in cases diagnosed as an intracranial space-occupying lesion. The localization of the space-occupying lesion in this clinical status, which is considered as a sign of herniation, is on the opposite side of the predicted side. The most typical finding is motor deficit and mydriasis on the same side as the space-occupying lesion. A 61-year-old female patient was evaluated in the emergency department due to sudden loss of consciousness. Her neurological examination revealed anisocoria and right hemiparesis findings, including mydriasis in the right pupil. Cranial computed tomography examination revealed a large, acute component combined with chronic subdural hematoma in the right frontoparietal region and midline shift. Clinical and radiological findings were evaluated as Kernohan’s Notch Sign phenomenon. The patient, who was operated on urgently, was discharged on the 7th postoperative day without any neurological deficits.

A CASE OF COMBINED CENTRAL AND PERIPHERAL DEMYELINATION IN A PATIENT WITH PEDIATRIC MULTIPLE SCLEROSIS AFTER SARS-COV-2 VACCINATION

2022-08-22T02:11:48+00:00

We present a case of combined central and peripheral demyelination in a patient with pediatric multiple sclerosis after the first dose of ChAdOx1-S (Chimpanzee Adenovirus Oxford 1) vaccination. The patient presented with ascending flaccid quadriparesis with respiratory failure that required mechanical ventilation. The lumbar puncture revealed albuminocytological dissociation, was negative for presence of JCV (John Cunningham Virus) in the CSF (Cerebrospinal Fluid) and ruled out other infections. A few days later he developed anisocoria and multiple new enlarging acute demyelinating lesions in the brain MRI (Magnetic Resonance Imaging). He was treated with intravenous immunoglobulin, corticosteroids and plasma exchange with gradual improvement. All other diseases were excluded via MR Spectroscopy, MR Angiography and serum and CSF laboratory investigations. Seven months later, the patient is under intense physiotherapy and is improving every day.

BENIGN IDIOPATHIC INFANTILE MASTURBATION: A CASE REPORT OF SEIZURE MIMICKING IN A 3-YEAR-OLD INFANT

2022-05-30T04:22:22+00:00

Background: Benign idiopathic infantile masturbation (infantile dyskinesia) or also known as gratification disorder is a rare abnormal paroxysmal movement disorder that occurs in children between 3 months and 3 years old. This disorder is characterized by self-stimulation of the genitalia and associated with unusual posturing and movements. Therefore, it could mimic as seizure.² The diagnosis of this disorder may be perplexing and scarcely reported.

Case Findings: We reported a 3 years old infant with abnormal behavior and posturing with rocking and thrusting movements accompanied by erection and clear secretion from his penis. The episodes were described as hip and knee flexion towards the abdomen, plantar flexion with flexion of the toes, extension of the elbows, clenched fists, and this behavior always occurred while lying in bed. Physical and neurological examination showed normal results. The electroencephalogram (EEG) was within normal limits hence done to exclude seizure as diagnosis. Parents were then educated and the child now does not show any previous behavior.

Conclusion: Benign infantile masturbation is a harmless behavior that is scarcely reported in journals and commonly mistaken as seizure. It presents with typical clinical characteristics and commonly found in females. However, our case report showed that this disorder may also be found in male with additional characteristics such as erection and clear secretion from the penis. To date, there is no exact treatment that could alleviate the symptom other than patient education.

Keywords: Gratification Disorder, Benign Infantile Masturbation.

HIGH-INTENSITY LASER THERAPY TO TREAT NEUROPATHIC PAIN IN POST-HERPETIC NEURALGIA

2022-03-23T13:04:42+00:00

Post-herpetic neuralgia (PHN) is chronic neuropathic pain that is felt for at least 3 months or more at the site of the rash due to herpes zoster infection. Epidemiological studies get a prevalence of 0.49 cases of PHN per 1000 people per year. The clinical manifestation of PHN is chronic pain on the skin lesions due to herpes zoster infection. The therapy that is commonly used as the first line is the provision of pharmacotherapy such as gabapentin or pregabalin. An 83-year-old male patient with a diagnosis of PHN that had been felt for 5 years. He has been taking drugs for 5 years but the pain has not improved. The patient is given high-intensity laser therapy. After 5 treatments with an interval of 1-2 weeks, pain was significantly reduced from an 8/10 scale to 4/10. The frequency of occurrence of severe pain is also reduced from 5 times per day to only 1 time per day. The use of high-intensity laser therapy is not commonly used as a therapy for PHN. Based on its mechanism of action, the use of high-intensity laser therapy is worth considering because of its effectiveness in treating pain in a shorter time than low-intensity laser therapy.

RAMSAY HUNT SYNDROME: A CASE REPORT

2022-05-23T02:56:46+00:00

Ramsay Hunt Syndrome (RHS) is a rare disease caused by reactivation of latent Varicella Zoster Virus in the geniculate ganglion which lead to inflammation, edema, and compression of facial nerve. RHS may affect both immunocompetent and immunocompromised patient. Clinical manifestation of RHS include herpes zoster oticus that manifest as vesicular rash on auricular area or oral mucosa in combination with peripheral nerve palsy. We reported a 67-years-old female patient with herpetic vesicle on left side of face and ear accompanied with ipsilateral peripheral facial paralysis since 2 days before admission. Patient was treated with acyclovir for 5 days. Follow up examination showed satisfying clinical improvement with disappearance of vesicles and otalgia, as well as facial weakness improvement from House Brackmann grade III to grade II. Early recognition and treatment of Ramsay Hunt Syndrome is crucial as delay of treatment may lead to sequelae, including postherpetic neuralgia and permanent facial paralysis.

DEALING WITH UNCONTROLLED SEIZURE IN CATAMENIAL EPILEPSY: A CASE REPORT

2022-12-15T06:25:17+00:00

Catamenial epilepsy refers to a seizure pattern that coincides with the menstrual period. Patients with catamenial epilepsy often leads to intractable epilepsy and may have an adverse impact on quality of life. Several medications are the therapeutic options, however, there is uncertainty regarding the best treatment, and these medications often fail to control the seizure. This makes catamenial epilepsy categorized as pharmaco-resistant epilepsy. This paper reported a case of perimenstrual catamenial epilepsy with an uncontrolled seizure problem. Seizures still occur with optimal management, and thereby clinicians must continue to re-evaluate clinical conditions and treatment selection to achieve optimal management. Personalized-based treatment should be considered in catamenial epilepsy management. This report discusses the challenges of catamenial epilepsy, understanding the catamenial process, and dealing with the problem with a practical personalized approach.

RELATIONSHIP BETWEEN LENGTH OF STAY FOR REHABILITATION AND FUNCTIONAL OUTCOMES IN STROKE PATIENTS

2022-01-21T02:59:36+00:00

Background: The comorbidities, age and disability of the stroke patients may influence the rehabilitation period. In the rehabilitation process of stroke patients, the length of stay in hospital is important because of its economic and psychological effects.

Objective: The purpose of this study was to evaluate whether there is a relationship between the length of hospital stay for rehabilitation and functional outcomes of stroke patients.

Methods: The medical records of 97 patients who were admitted to a rehabilitation unit were analyzed retrospectively. The functional output, the level of spasticity, and motor development at admission and discharge were determined using the Functional Independence Measure instrument, the Modified Ashworth Scale, and the Brunnstrom test, respectively. Based on the length of hospital stay, patients were divided into two groups: hospital stays ≤ 3 months (Group 1) and > 3 months (Group 2). Clinical features and functional output were then compared between the groups.

Results: The gain of Functional Independence Measure instrument -total and Functional Independence Measure instrument-motor scores were significantly higher in Group 1 (n=74) (p < 0.05) than Group 2 (n=23). The Modified Ashworth Scale scores of the upper extremities and of the lower extremities at admission and discharge were significantly higher in Group 2 (p < 0.05 for all).

Conclusion: The findings of this study revealed that a prolonged length of hospital stay has no greater positive effect on improvement of functional outcomes and spasticity of stroke patients.

THE EFFECTS OF SHORT/LONG-TERM ADMINISTRATION OF DUAL ANTIPLATELET THERAPY ON RESTENOSIS IN PATIENTS WITH CAROTID ARTERY STENTING

2022-05-23T02:34:06+00:00

Background: There is no consensus on the duration of dual antiaggregant therapy after carotid stenting. This study aimed to evaluate the early contribution of dual antiaggregant therapy for three or six months to stent restenosis.

Objective: This study aimed to identify the correlation between stent restenosis and the duration of dual antiplatelet therapy (DAPT) in carotid artery stenting (CAS) subjects by retrospectively scanning a CAS procedure dataset.

Methods: Patients who underwent a CAS procedure received dual DAPT (acetylsalicylic acid (ASA) + clopidogrel) were recruited for this study. The first group was the patients who received dual antiaggregants for three months, and the second group was the patients who received dual antiaggregants for six months. Patients' demographic characteristics, comorbidities, and radiological results were reviewed. Follow-up activities for the following six months were assessed for stent status, complications, and new ischemic lesions.

Results: A total of 65 patients received ASA (acetylsalicylic acid) + clopidogrel for six months, while the remaining 118 patients were treated for three months. The restenosis rates were not significantly different between the two groups. The complication and adverse event frequencies were also similar.

Conclusion: This study revealed that the efficacy of 3-month and 6-month DAPT is similar regarding the restenosis frequency, and there are no significant differences in complication frequency.

THE DISEASE PATTERN OF ELDERLY PATIENTS ADMITTED IN THE NEUROLOGY WARD OF HASAN SADIKIN GENERAL HOSPITAL

2022-03-04T03:37:48+00:00

Background: As life expectancy continues to increase, the elderly population in Indonesia has significantly doubled in the last five decades, making Indonesia a home to 4^th largest population of elderly people in Asia. Unlike other age group, there are more challenges in handling older persons due to their increased mortality, morbidity, and disability risks.

Objective: We performed this study to understand the disease pattern in elderly patients admitted in the neurology ward of Hasan Sadikin General Hospital.

Methods: This was a descriptive cross-sectional study using data from medical resume. We included medical resume of elderly patients admitted in the neurology ward of Hasan Sadikin General Hospital from January 2015 to December 2019. All incomplete, lost, or inaccessible medical resumes were excluded.

Results: Among a total of 400 subjects, 210 (52.5%) were males and 190 (47.5%) were females. Young old (59,5%) presented to be the most observed age group. The most frequent diseases of elderly patients seen in this study were ischemic stroke (55.3%), followed by hemorrhagic stroke (19.5%), subarachnoid hemorrhage (5.3%), and tetanus (4.5%). Atherothrombotic subtype (50,6%) of ischemic stroke was seen to be the most frequent.

Conclusion: Noncommunicable diseases were the majority of all cases in the elderly with cerebrovascular diseases, such as stroke and subarachnoid haemorrhage, as the most common conditions. It is important to develop efficient hospital-based management strategies particularly for these diseases and intensify early detection and management of risk factors.

CLINICAL OUTCOME OF STROKE PATIENTS BASED ON THE NATIONAL INSTITUTES OF HEALTH STROKE SCALE (NIHSS) IN A TERTIARY HOSPITAL

2022-03-04T04:29:39+00:00

Background: Stroke is the second leading cause of death and the third cause of disability globally. Clinical outcomes caused by stroke are varied and influenced by various factors.

Objective: This study aims to describe the clinical outcome of stroke patients based on neurological deficit using NIHSS at Dr. Hasan Sadikin General Hospital, Bandung.

Methods: This study is a retrospective descriptive, cross-sectional study using secondary data from medical records recruited between January 2019 – December 2019 at the Department of Neurology Dr. Hasan Sadikin General Hospital Bandung with the total sampling method. Variables include demographic data, risk factors, and clinical characteristics. Neurological deficit was assessed using NIHSS. Data were analyzed and presented in the form of tables.

Results: There were 202 subjects eligible for this study, including ischemic (71.8%) and intracerebral hemorrhage (28.2%) stroke patients. Most of the subjects were male (53%), aged ≥60 years (50,5%), presenting with onset >6 hours (72.3%), and had hypertension (92,1%). Most of the subjects have a moderate stroke (n=102;50.5%) based on the NIHSS score at admission and mild stroke (n=117;57.9%) based on the NIHSS score at discharge, with a motor deficit as the most common neurological deficit found.

Conclusion: The majority of stroke patients presented with a moderate stroke on admission and had a clinical improvement during hospital treatment, with most of the patients experiencing a mild stroke on discharge based on NIHSS score. The motor deficit is the most common neurological deficit that affects clinical outcomes.

CHARACTERISTICS OF ACUTE ISCHEMIC STROKE PATIENTS DUE TO SMALL VESSEL OCCLUSION

2022-07-22T07:32:42+00:00

Background: Ischemic stroke account for about 87% of all stroke cases. This study will focus on ischemic stroke due to small vessel occlusion as one of the subtypes based on TOAST (trial of ORG 10172 in acute stroke treatment).

Objective: To determine the characteristics of ischemic stroke patients caused by small vessel occlusion and are expected to be used as a basis for further research.

Methods: A descriptive observational retrospective study regarding the characteristics of acute ischemic stroke patients due to small vessel occlusion at Sanglah Hospital. Secondary data were obtained from patient medical records.

Results: The total number of cases of small vessel occlusion was 338. The majority of the sample were men (64.5%) between 40-60 years old (53.6%). Most of the samples were patients who had experienced an ischemic stroke for the first time (75.1%) with NIHSS (National Institute of Health Stroke Scale) scores showing mild (48.2%) and moderate (51.5%) symptoms. Around half of them had a history of hypertension (60.1%), dyslipidemia (59.5%), and diabetes mellitus (44.1%). The most common location of infarction was in the anterior circulation (77.5%) with almost the same ratio of right and left hemisphere locations.

Conclusion: Ischemic stroke due to occlusion of small vessels at Sanglah Hospital Denpasar for 3 years was 35.2% of the total ischemic stroke cases. Half of the total sample had classic vascular risk factors. Further research is needed to determine another effective treatment strategy other than just secondary prevention such as life style moderation to prevent recurrency.

NEUROLOGICAL ADVERSE EVENTS FOLLOWING IMMUNIZATION (AEFI) ON HEALTH WORKFORCE OF A SECONDARY REFERRAL HOSPITAL IN SOUTH SULAWESI WHO RECEIVED THE

2022-07-12T04:02:25+00:00

Background: The COVID-19 vaccination can relate to the occurrence of neurological adverse events following immunization (AEFI) that could impact work and daily activities. This problem is particularly important in the health workforce. However, little is known about neurological AEFI among the health workforce working in peripheral facilities.

Objective: To study the neurological AEFIs and their impact among the health workforce who received the COVID-19 vaccination in a secondary referral hospital in South Sulawesi, the Andi Makassau Hospital (Rumah Sakit Umum Daerah Andi Makassau/RSAM).

Methods: The COVID-19 pandemic, we created a questionnaire about neurological AEFIs and their effects which were distributed online using the Google Form application to the health workforce at the RSAM who had received at least one dose of COVID-19 vaccination.

Results: We obtained 97 subjects. There were 78.5% neurological AEFIs with the most reported type being muscle pain (16%). Most neurological AEFIs were experienced by women (84.9%), age group 21-35 years (53.8%), and non-doctors/nurses (60.8%). The significant influencing factors in multivariate analysis were age group 36-45 years (p = 0.04), nursing proffesion (p = 0.005), and non- viral-based baccine type (p = < 0.0001).

Conclusion: Neurological AEFI is commonly found among the health workforce who received the COVID-19 vaccination. However, it only has a little impact on their work and attitudes towards vaccination. This may be because all subjects experienced mild neurological AEFI.

FACTORS AFFECTING THE FUNCTIONAL STATUS OF PATIENT WITH MENINGIOMA IN DR. SAIFUL ANWAR GENERAL HOSPITAL MALANG

2022-05-19T04:51:01+00:00

Background: Meningioma is one of the most commonly reported primary central nervous system (CNS) tumors, originating from arachnoid meningeal cells and including intracranial extra-axial neoplasms. Although meningioma is considerably benign, the patient conditions are reported to be diverse resulting in severe and life-threatening neurological deficits. Hence the assessment regarding functional status is deemed pivotal to provide a prognostic perspective as patient presentation exhibits disability due to lesions and other factors.

Objective: This research aims to analyze factors affecting the functional status of patients with meningioma in Dr. Saiful Anwar General Hospital Malang.

Methods: An analytic retrospective study was conducted with cross-sectional study involving 62 samples from patients visits with meningioma brain tumor in RSUD dr. Saiful Anwar General Hospital Malang from January 2017 to December 2020. The data was selected through non-probability sampling, generating sampling type from brain tumor register data Neurology.

Results: Data obtained from 62 meningioma patients in RSUD dr. Saiful Anwar General Hospital Malang met the inclusion criteria from January 2017 to December 2020, based on demographic characteristics such as age of <50 in 38 patients (61.3%) and age of >50 in 24 patients (38.7%). Clinically, it was found that 58 patients (93.5%) experienced headache, 28 patients (45.2%) experienced decreasing consciousness, 15 patients (24.2%) had hemiplegia, and 17 patients (27.4%) had hemiparesis, 17 people had hemiparesis. 17 patients (27.4%) experienced visual disturbances, and 24 patients (38.7%) are with seizures. Based on the radiology screening sites, 46 patients (74.2%) were screened in Convexity sphere, 9 patients (14.5%) were screened at Cranial base, 3 patients (4.8%) were screened at Parasagittal, and 4 patients (6.5%) were screene at Falx, from which the 41 patients (66.1%) exhibited herniation. Based on comorbidities, 12 patients (19.4%) had sepsis, and 1 patient (1.6%) had pneumonia. From the analysis test results, it was found that decreasing consciousness (GCS) was significantly correlated with functional status, referred to Karnofsky Performance Scale of <70 (p: 0.013, p <0.05). Seizures were reported to be correlated significantly with functional status, referred to Karnofsky Performance Scale of > 70 (p: 0.015, p<0.05). Tumor location was significantly correlated with functional status, reffered to Karnofsky Performance Scale of > 70 (p: 0.027, p<0.05).

Conclusion: The factors affecting the functional status based on the Karnofsky Performance Scale (KPS) of a patient with meningioma at Dr. Saiful Anwar General Hospital Malang included: decreasing consciousness (GCS), and seizures, and tumor location.

COCCYDYNIA: A NARRATIVE REVIEW OF PATHOPHYSIOLOGY, ETIOLOGY AND TREATMENT

2022-05-25T02:12:12+00:00

Pain and discomfort in the coccyx or tailbone area is called as coccydynia or coccygodynia. Despite its small size, the coccyx, which forms the terminal of the spine, has an important role to support the balanced distribution of body weight, especially in the sitting position, due to its relationship with the surrounding muscles, ligaments and bone structures. The problems of this area for various reasons manifests itself with localized discomfort and pain in the sacrococcygeal region. Our aim in this paper is to review the etiology, pathophysiology, clinical findings, diagnosis and treatment methods of coccydynia in light of the current literature.

HEADACHE MANIFESTATION OF COVID-19: A CASE SERIES AND NARRATIVE REVIEW

2022-04-21T04:34:10+00:00

Despite the typical primary symptoms reported, the coronavirus disease 2019 (COVID-19) outbreak could be manifested as many symptoms. Neurological manifestations of COVID-19 are hypothesized to be caused by multiple pathophysiologies. As one of the possible prodromal symptoms in the absence of fever and respiratory symptoms, many individuals might be unaware of contracting COVID-19 infection and could possibly infect other people. This case series involved a hundred and twenty COVID-19 patients in which nine of them reported headaches as the chief complaint to provide the prevalence rate. Medical histories were assessed to provide the prevalence rate and laboratory findings of involved subjects. Narrative review of possible mechanisms of the manifestation were also denoted. To date, the proportion of non-specific manifestations as the first symptom needs to be further explored as it could be one of the initial symptoms and early manifestations of COVID-19.

GRAPE SEED EXTRACT’S NEUROPROTECTIVE EFFECT AND PARKINSON’S DISEASE: A SYSTEMATIC REVIEW

2022-07-22T07:27:49+00:00

Parkinson’s disease (PD) is the most common neurological disease globally, only second to Alzheimer’s disease. One of the emerging treatments for PD is nutraceuticals. Grape seed extract (GSE) has a high concentration of polyphenolic compounds possessing antioxidant and neuroprotective capacity that may be valuable for neurodegenerative diseases. So far, there is no review summarizing the neuroprotective effect of GSE on PD, even though it is crucial to provide an insight into GSE as a potential natural treatment for PD. This systematic review aims to summarize the neuroprotective effect of grape seed extract (GSE) in Parkinson’s Disease in vivo and in vitro and their mechanism. The author performed a literature search using PubMed, Science Direct, Scopus, Sinta, and Garuda databases with keywords comprising “Neuroprotective”, “Grape Seed,” and “Parkinson’s disease.” Out of 1611 studies retrieved, 20 articles fit the inclusion criteria and became the basis for this review. The author analyzed and extracted the records regarding the neuroprotective effect and potential anti-PD properties from the studies. The analysis summarized that GSE could significantly improve the biological hallmarks of PD with numerous mechanisms, including antioxidant, anti-inflammation, protection of dopaminergic neurons, anti-amyloid effect, anti-apoptotic, neurogenesis, and synaptogenesis. Although the precise mechanism underlying PD is still elusive, treatment should target not only a single cause of PD but instead several pathways that could lead to the disease. In conclusion, GSE should be considered a potential nutraceutical in clinical trials to prevent and alleviate Parkinson’s disease by multiple mechanisms.